Appendicitis

Learn What to Expect from Appendix Removal in Children

What Is Appendicitis?

Appendicitis is caused by inflammation of the appendix. The appendix is a small narrow pouch that hangs off of the side of the intestines around the location where the small intestine meets the large intestine. The purpose of this pouch is not known. Due to its location, it is possible for small pieces of stool or food to become lodged in this narrow pouch and block it. This prevents normal secretions from exiting the appendix. The appendix can become swollen, inflamed, and infected. This inflammation causes pain for your child. If the appendix is not removed, it will eventually perforate/burst and spread infection throughout the abdominal cavity. There is not a certain food that your child ate that caused this.

Who gets appendicitis?Appendicitis mostly affects kids and teens between 4 and 15 years old, and is rare in infants. Only 7 percent of people have their appendix removed in their lifetime.

How is appendicitis diagnosed? If your child has appendicitis, he/she may have:

Pain around the belly button, which then moves to lower right side of the abdomen

Nausea/vomiting

Small amount of diarrhea

Fever (but not always)

The doctor will gently push on your child’s abdomen to see if he or she has a spot that is tender. You child may need blood tests, an ultrasound, or a CT scan, Hospitalsto confirm the diagnosis. If the physical exam, blood test, and scans all point to an infection in the appendix, your doctor will recommend removing the appendix.

What can I expect from surgery?In the laparoscopic method, the surgeon will:

make three small (less than 1 inch) incisions in the belly

insert a small scope with a tiny camera on the end through one of the incisions

put air through the tube of the scope to get a good view through the scope

use tools that he/she will insert through the other two incisions to grasp and remove the infected appendix

close the bowel and the small incisions with dissolving stitches

put surgical tape or glue over the incisions

What should I expect after surgery? Your child may receive fluids and antibiotics through an IV line after surgery. Everybody feels differently after awakening from surgery. Some children are wide awake and others are groggy. The nurse will listen to the abdomen and determine if your child has bowel sounds. After making sure that the intestines “wake up” after surgery, your child may be able to drink clear liquids. If he/she tolerates clear liquids without any nausea or vomiting, your child can eat solid food such as crackers, saltines, Pop Tarts, etc.

What will you do to keep my child comfortable?To ensure we successfully manage any pain your child has, we like to start oral narcotic pain medicine right after your child tolerates solids. Pain following laparoscopic appendectomy is significantly less than that associated with the open operation, but some discomfort in the abdomen and shoulder will occur. This pain gradually tapers off and ends within 36 hours. While in the hospital, your child will be asked to walk several times a day, beginning the night of surgery or the following morning. Increased activity reduces pain, expands the lungs, prevents pneumonia, and reduces risk of blood clots.

When will my child be able to go home?Your child can go home in less than 24 hours after surgery if he/she:

tolerates a regular diet

takes pain medications by mouth

does not have a fever (101° F)

What care does my child need at home after surgery?

Bathing: Your child may take a shower/bath 48 hours after surgery. Remove gauze and tegaderm dressing before the shower. Please, do not remove steri strips. Steri strips will fall off their own in seven to 10 days after surgery.

Activity: Your child should be out of bed and walking around but not riding a bike, playing sports or other contact activities. Children can usually return to school a few days after going home. They should not participate in sports or physical education for at least two weeks. Your child will be cleared for activities after the follow-up appointment with the doctor in two weeks.

Diet: Resume your child’s usual diet.

Medication: Your child will receive pain medication before leaving the hospital. Most children need some pain medicine for a few days after coming home.

Call you doctor if your child has:

Fever greater than 101° F

Redness/foul drainage around incisions

Vomiting/diarrhea

Low fluid intake

Increased or different abdominal pain

Pain gets worse or is not relieved by prescription pain medications

Follow Up If your child had acute appendicitis and had a straightforward, one-day recovery, the surgeon does not need to see you back in the office unless you have any issues, complications or questions. Children usually heal very well following this illness. A nurse from our pediatric surgery office will call you at home and one or two days to check and see how your child is doing and to see if you have any questions.

If your child had a ruptured (perforated) appendix, the surgeon will want to see your child back in the office in approximately two weeks. The appointment will be made for you prior to your leaving the hospital. If you leave during the weekend, please call our office the following Monday to schedule an appointment. A nurse from our pediatric surgery office will call you at home in one or two days to check and see how your child is doing and to see if you have any questions.